The time was around 11 pm on August 2, 1994. I was still in my office in the ICU area; it had been a long day, what with one thing or the other. Through the day, there had been parleys regarding a potential donor, but nothing conclusive, and I was beginning to tire of the constant shuffling back and forth with multiple stakeholders in the picture. We had a few people earmarked as potential recipients, and it broke my heart to see the hope dim just a bit more in their eyes by the end of every day.
And then, suddenly, the phone lines started jangling with renewed urgency. There was a swift flurry of activity between the neurosciences and cardiothoracic–vascular surgery centres. “We have the family’s acceptance. . .The family is ready to donate. . .Hurry, hurry, are you ready?” But of course, we were ready! We swung into action with the preparation; Devi Ram, aged 40 years, had the matching AB-positive blood group. We had admitted him a few weeks ago in CT 5, bed 4, and his being co-located with the donor proved to be an added boon. He was a lathe worker and we knew that he was truly at end-stage, just holding on to the hope of getting a healthy heart.
I had always found him to be positive, with great faith in what we could do for him, and I felt a small surge of joy that we could finally attempt to help him. He was wheeled into the OT from the ward. At the same time, the AIIMS panel of neurologists and the attending physician, cardiac surgeon and medical superintendent began the process of certifying the donor, a lady in her mid-thirties, as brain dead and fit for donating. Around 2 am, she was brought into OT 4, and the process of heart harvesting began, led by Bhaba Nanda Das. In adjacent OT 1, under my supervision, the recipient was being cut open in readiness for the transfer. At about 3 am, I saw Bhaba Nanda Das walk in with the donor heart packed in ice, and the process of transplanting began.
I knew people had constantly spoken of the stakes being so high, and yet I worked on with clear certainty. It was only when I took out Devi Ram’s diseased heart that it dawned on me that this was now irreversible, and I better make good!
I’m not sure what went on in the minds of my amazing team as they worked shoulder-to-shoulder, hand-to-hand with me that night, but there was a calm and rehearsed rhythm in the OT. On the surface it was pretty much like an open-heart bypass that we did every single day, but at the back of my mind ticked the persistent thought: “We have to make it, we have to succeed, else this will clamp down on the transplantation programme even before it begins.” Only one such attempt had been made many years ago in India, with the patient dying on the operating table, and at no cost did I want a repeat! It took all of fifty-nine minutes to have the heart in and working on the bypass – and then it started beating on its own! That first – ironically heart-stopping – tick-tock remains special even today, even though I’ve held my breath at this point in a surgery multiple times every day for all my life.
Five hours later, we knew we had passed the operation phase with flying colours. I just wanted to clear my head, and decided to walk back home to take a quick shower and change. On the way back, I ran into the medical superintendent, Dr Dave, and broke the news to him. He pulled me along to go and inform B Shankaranand, then health minister and AIIMS president, who was on the premises. He insisted that we issue a press release. The first thing I did after returning to the ICU and checking on the patient was pick up the phone and call Dr Gopinath at his Preet Vihar home. He was ecstatic, and it was then that it sank in – our old dream, the long years of studying and preparing, the challenges and the disappointments, the guinea pigs and the horses, the jealousies and the jibes – everything had all culminated into this day. Our day in history.
To be honest, in all my years of preparation leading up to this point, I had never prepared for – or even thought about – the response and reaction to a successful (or unsuccessful!) outcome. Once we issued the press release the floodgates opened, and I was in shock, unprepared for the overwhelming reactions.
My instinctive response was to run for cover and hide far away from the limelight. But I realised that there was a duty I had to complete. I needed to be visible; there was a responsibility I owed to the country, to the media and to the medical fraternity who wanted to know all about this breakthrough. The reactions ranged from the extremely cynical to the overwhelmingly laudatory. The next few days, weeks and months became a roller-coaster, where one day we were receiving the highest accolades in the land and the next we were pulled deep into a morass of negativity.
When the country awoke to the headlines on August 4, 1994, there was instant euphoria. Many did not understand the finer nuances, but the very fact that an incredible medical feat had been performed in our own country by our own doctors spread cheer and hope. Not many people knew that way back in February 1968, Dr PK Sen of King Edward Memorial Hospital had attempted a human-to-human heart transplant, but the patient had died within a few hours. For those who knew, this was, therefore, a sweeter success.
On August 5, Parliament gave us a standing ovation. On the other hand, many in the medical profession pooh-poohed the achievement. Rumours flew thick and fast – the patient had actually died; it was not I but Bhaba Nanda Das who had done the transplant, etcetera, etcetera. Some even went so far as to say that in a country where malaria was not eradicated, what was the good of doing heart transplants!
Excerpted with permission from Heartfelt: A Cardiac Surgeon’s Pioneering Journey, P Venugopal and Priya Sarkar, HarperCollins India.